Provider Demographics
NPI:1083937486
Name:CLEAR CREEK COUNSELING LLC
Entity Type:Organization
Organization Name:CLEAR CREEK COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:F
Authorized Official - Last Name:OEDEKOVEN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, LAT, NCC
Authorized Official - Phone:307-686-9422
Mailing Address - Street 1:801 E. 4TH ST.
Mailing Address - Street 2:SUITE 24
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716
Mailing Address - Country:US
Mailing Address - Phone:307-686-9422
Mailing Address - Fax:307-686-3833
Practice Address - Street 1:801 E. 4TH ST.
Practice Address - Street 2:SUITE 24
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716
Practice Address - Country:US
Practice Address - Phone:307-686-9422
Practice Address - Fax:307-686-3833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-12
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC540101Y00000X
WYLPC-372101Y00000X
WY540251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty